Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes

Sermer, Mathew; Naylor, C. David; Gare, Douglas J.; Kenshole, Anne B.; Ritchie, J. W. K.; Farine, Dan; Cohen, Howard; McArthur, Karen; Holzapfel, Stephen; Biringer, Anne; Chen, Erluo

doi:10.1016/0002-9378(95)90183-3

Cited by 462 publications

(286 citation statements)

References 17 publications

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“…Defined by WHO criteria, GDM predicted similar increased risks of macrosomia and preeclampsia (45 and 94%, respectively) but a notably lower increased risk of a perinatal death (59%; NS). Our results confirm that GDM is independently associated with macrosomia and preeclampsia, as previously demonstrated by two other large cohorts of American and Canadian women (11,12). More importantly, they show, to our knowledge for the first time, that GDM, independent of age, obesity, and other risk factors, predicts perinatal mortality.…”

Section: Research Design and Methods -supporting

confidence: 91%

Gestational Diabetes Mellitus Diagnosed With a 2-h 75-g Oral Glucose Tolerance Test and Adverse Pregnancy Outcomes

Schmidt

Duncan²,

Reichelt³

et al. 2001

Diabetes Care

329

204

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FOR THE BRAZILIAN GESTATIONAL DIABETES STUDY GROUPOBJECTIVE -To evaluate American Diabetes Association (ADA) and World Health Organization (WHO) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes. RESEARCH DESIGN AND METHODS -This cohort study consecutively enrolledBrazilian adult women attending general prenatal clinics. All women were requested to undertake a standardized 2-h 75-g oral glucose tolerance test (OGTT) between their estimated 24th and 28th gestational weeks and were then followed to delivery. New ADA criteria for GDM require two plasma glucose values Ն5.3 mmol/l (fasting), Ն10 mmol/l (1 h), and Ն8.6 mmol/l (2 h). WHO criteria require a plasma glucose Ն7.0 mmol/l (fasting) or Ն7.8 mmol/l (2 h). Individuals with hyperglycemia indicative of diabetes outside of pregnancy were excluded.RESULTS -Among the 4,977 women studied, 2.4% (95% CI 2.0 -2.9) presented with GDM by ADA criteria and 7.2% (6.5-7.9) by WHO criteria. After adjustment for the effects of age, obesity, and other risk factors, GDM by ADA criteria predicted an increased risk of macrosomia (RR 1.29, 95% CI 0.73-2.18), preeclampsia (2.28, 1.22-4.16), and perinatal death (3.10, 1.42-6.47). Similarly, GDM by WHO criteria predicted increased risk for macrosomia (1.45, 1.06 -1.95), preeclampsia (1.94, 1.22-3.03), and perinatal death (1.59, 0.86 -2.90). Of women positive by WHO criteria, 260 (73%) were negative by ADA criteria. Conversely, 22 (18%) women positive by ADA criteria were negative by WHO criteria.CONCLUSIONS -GDM based on a 2-h 75-g OGTT defined by either WHO or ADA criteria predicts adverse pregnancy outcomes.

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Section: Research Design and Methods -supporting

confidence: 91%

Gestational Diabetes Mellitus Diagnosed With a 2-h 75-g Oral Glucose Tolerance Test and Adverse Pregnancy Outcomes

Schmidt

Duncan²,

Reichelt³

et al. 2001

Diabetes Care

329

204

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“…Interestingly, our demonstration that, compared with their truly normal peers with normal GCT NGT, women with GIGT and even those with abnormal GCT NGT have metabolic perturbations that translate into an increased risk of postpartum glucose intolerance is consistent with an emerging body of literature indicating that these two groups (like women with GDM) have an enhanced risk of adverse obstetrical outcomes (22)(23)(24)(25)(26)(27). These obstetrical data have posed the question as to whether glucose-lowering treatment in pregnancy, as prescribed for GDM, should be instituted for these groups of women.…”

Section: Determinants Of Postpartum Glucose Intolerancesupporting

confidence: 78%

Glucose Intolerance in Pregnancy and Future Risk of Pre-Diabetes or Diabetes

Retnakaran

Qi²,

Sermer³

et al. 2008

Diabetes Care

Self Cite

220

219

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OBJECTIVE -The purpose of this study was to test the hypothesis that any degree of abnormal glucose homeostasis detected on antepartum screening for gestational diabetes mellitus (GDM) should be associated with an increased risk of postpartum pre-diabetes or diabetes.RESEARCH DESIGN AND METHODS -In this prospective cohort study, 487 women underwent 1) antepartum GDM screening by a glucose challenge test (GCT) and a diagnostic oral glucose tolerance test (OGTT) and 2) postpartum metabolic characterization by OGTT at 3 months after delivery. Four baseline glucose tolerance groups were defined on the basis of the antepartum GCT/OGTT: 1) GDM (n ϭ 137); 2) gestational impaired glucose tolerance (GIGT) (n ϭ 91); 3) abnormal GCT with normal glucose tolerance on an OGTT (abnormal GCT NGT) (n ϭ 166); and 4) normal GCT with NGT on an OGTT (normal GCT NGT) (n ϭ 93).RESULTS -The prevalence of postpartum glucose intolerance (pre-diabetes or diabetes) increased across the groups from normal GCT NGT (3.2%) to abnormal GCT NGT (10.2%) to GIGT (16.5%) to GDM (32.8%) (P trend Ͻ 0.0001). On logistic regression analysis, all three categories of abnormal glucose homeostasis in pregnancy independently predicted postpartum glucose intolerance: abnormal GCT NGT odds ratio (OR) 3.6 (95% CI 1.01-12.9); GIGT OR 5.7 (1.6 -21.1); and GDM OR 14.3 (4.2-49.1). Furthermore, both in pregnancy and at 3 months postpartum, insulin sensitivity (IS OGTT ) and pancreatic ␤-cell function (insulinogenic index/ homeostasis model assessment of insulin resistance) progressively decreased across the groups from normal GCT NGT to abnormal GCT NGT to GIGT to GDM (all P trend Ͻ 0.0001).CONCLUSIONS -Any degree of abnormal glucose homeostasis in pregnancy independently predicts an increased risk of glucose intolerance postpartum.

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“…It remains to be determined, however, whether these current strategies can effectively reduce long-term risks of metabolic syndrome, T2DM and CVD in affected women (Nolan, 2011). Indeed, women who do not meet the prescribed thresholds for GDM may incur glucose-mediated fetal macrosomia (Mello et al, 1997;Rudge et al, 2000;Scholl et al, 2001;Sermer, et al, 1995), and may be at risk for T2DM and CVD (Retnakaran et al, 2008a(Retnakaran et al, , 2008b(Retnakaran et al, , 2009a(Retnakaran et al, , 2009b(Retnakaran et al, , 2009c(Retnakaran et al, , 2009d(Retnakaran et al, , 2009e, 2010cShah et al, 2008). The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was undertaken to examine the risks associated with glucose values below traditional thresholds used to diagnose GDM.…”

Section: Controversy Regarding Gdmmentioning

confidence: 99%